
Insurance
Do you accept my insurance?
Answer: We are not “in-network” with any insurance company; however, we will file all insurance claims as a courtesy for our patients. Your insurance company may “accept assignment of benefits”, meaning they may pay us directly or they may not. If your insurance company accepts assignment of benefits, we will estimate the portion we believe they will not cover and collect that on the day of treatment. If your insurance company does not accept assignment of benefits, you will have to pay the total charges, we will file the insurance claim, and they will pay you directly.
Why do I have to pay more than the percentage my insurance policy specifies for a procedure?
Answer: Most insurance plans pay percentages based on what they consider usual, customary, and reasonable (UCR). They will pay the percentage designated for the procedure based on what they determine the allowed amount is for each procedure. UCRs are based on how the plan has been negotiated between the insurance company and your employer.
For example, if a regular dental cleaning costs $92, your insurance company may consider $82 as UCR and they pay 100% of UCR, meaning the portion you owe is $10.
All insurance companies are different and there is no way for us to know exactly what each plan will pay, therefore, we estimate your portion to the best of our ability. Some insurance plans pay based on a “fee schedule”; they have a set fee they will pay for each procedure, the fees are not based on a percentage of UCR. With these plans, the fee schedule is usually listed in the subscribers’ policy booklet. For more information see the brochure “My insurance covers this…. Right?” at: http://www.steppingstonestosuccess.com/products/broc-ins2.pdf